Cornell President Promises Holistic Review of Student Mental Health

Cornell University President Martha E. Pollack says that Cornell will be conducting a “comprehensive review” of student mental health, possibly beginning in early 2019. She says the “team” at Cornell Health had advocated for the review “to provide an opportunity to look holistically at mental health on our campus.”

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Cornell University campus

Pollack’s statement came in a letter dated September 20 to Scott MacLeod and Susan Hack, the co-founders of The Sophie Fund. In a letter dated August 23, they had called on Pollack to “appoint without further delay an independent, external-led task force to review and assess the mental health challenges for Cornell students, and the university’s policies, practices, and programs to address them; and to make recommendations to the Cornell President to ensure that the university is implementing current best practices.”

MacLeod and Hack published their letter to Pollack in a blog post on September 8 headlined, “Time for a Mental Health Task Force at Cornell.”

In her reply to the MacLeod/Hack letter, Pollack said: “We will be conducting a comprehensive review of student mental health at Cornell… The team at Cornell Health—those in both clinical and educational roles—have advocated for this review to provide an opportunity to look holistically at mental health on our campus.”

Pollack said that Cornell Health “will work with the campus community” beginning this semester “to determine the appropriate scope for this review, which could potentially begin in early 2019.”

Pollack thanked MacLeod and Hack “for your advocacy for providing the best possible environment to support the mental health of Cornell students.”

Pollack’s letter did not respond directly to MacLeod/Hack’s request for an “independent, external-led” review. In their letter, they wrote: “The independent task force should be led by a recognized public health expert with a strong background in mental health and without any current or previous ties to Cornell or to organizations and professional associations focused on collegiate mental health.”

In a September 18 email to Cornell students reported by the Cornell Daily Sun, Vice President Ryan Lombardi announced plans for “a comprehensive review of student mental health” that will bring together “internal and external partners.”

In a September 18 email to the Sun, Lombardi said: “While for many years the university has engaged in regular assessment of student mental health needs and evaluation of services and programs, the decision to pursue an additional comprehensive review of student mental health reflects the University’s commitment to promoting health and well-being as a foundation for academic and personal success.”

In a statement to the Graduate and Professional Student Assembly (GPSA) on September 24 reported by the Sun, Lombardi said he “can’t speak … to exactly who” will be conducting the review but that the administration does “envision it being external audiences.”

“I think part of the first step is to understand what we want to look at, and then I think that will really inform that broader question about who’s best to come in,” he said. “Obviously I think we’re going to want people to have expertise in mental health. I don’t want that just to be Cornell folks.”

In her letter to MacLeod and Hack, Pollack noted that the intention to conduct a comprehensive review was cited in an update about “diversity and inclusion” initiatives posted on the Office of the President’s website, apparently in early September, and announced in Lombardi’s email to students on September 18. The reference read as follows:

Conduct a comprehensive review of student mental health.

Cornell Health will work with the campus community during the fall 2018 semester to determine the appropriate scope for a comprehensive review of student mental health at Cornell, anticipating that such a review could potentially begin in early 2019.

MacLeod and Hack, whose daughter Sophie (’14) died by suicide while on a health leave of absence in 2016, initially wrote to Pollack on April 19, 2017 detailing their concerns about “systemic failure” in Cornell’s institutional handling of mental health matters, and calling on her to launch an independent task force review. However, in a letter to MacLeod and Hack on January 11, 2018, Pollack declined their request, citing an “external assessment” conducted by The JED Foundation, JED’s on-site visit to the Cornell campus in the summer of 2017, and Cornell’s “ongoing engagement with the foundation to ensure we are providing holistic support.”

MacLeod and Hack said that they wrote to Pollack in August asking her to reverse her decision after studying the JED review and finding it “plainly insufficient.” They said a glaring omission was the lack of any reference in findings or recommendations regarding the capacity of the Counseling and Psychological Services staff to meet the demands of students for services. Another omission, they said, was the lack of any reference to the capacity of community mental health providers to address the needs of Cornell students referred to those off-campus services by CAPS. They said that the JED-review documents reported no findings and recommendations in areas such as academic workloads and faculty and academic staff handling of students in distress, and appeared to lack a comprehensive assessment of Cornell’s suicide prevention policies and practices.

MacLeod and Hack also questioned the independence of the review, pointing out that institutions of higher education pay The JED Foundation a fee to become what JED calls “partners” in the JED Campus program. They also said that the JED review entailed only one on-site campus visit by a JED External Contributor, one that lasted merely three hours and did not include meetings with any of the community providers who receive many CAPS referrals. They also said it appeared that Cornell had not released all relevant documents pertaining to the JED review.

In response to Pollack’s September 20 letter, MacLeod and Hack said in a statement:

“We welcome President Pollack’s personal engagement and specifically her commitment to conducting a comprehensive review of student mental health at Cornell. We commend Cornell Health for advocating for this review “to provide an opportunity to look holistically at mental health on our campus,” as President Pollack said. Lastly, we are encouraged to know that the Cornell administration will consult with students and other members of the community as the review proceeds.

“There is a mounting mental health crisis facing our young people today, and the goal of the comprehensive review should be not merely to tinker with the existing system but to create a gold standard for supporting student mental health in the years to come. As one of the world’s leading research institutions, Cornell should expect no less of itself.

“We continue to stress the importance of a truly independent, robust, and transparent review, led by an external expert—a recognized public health authority with a strong background in mental health and without any current or previous ties to Cornell. This is vital, both to ensure the best possible outcome and to win the confidence of Cornell students and the wider campus and Ithaca communities that the university administration is doing its utmost to support student mental health.”

The full September 20, 2018 letter from President Pollack:

Dear Ms. Hack and Mr. MacLeod,

Thank you for your letter dated august 23, 2018, and for your care and concern for the mental health and well-being of Cornell students.

As you may have seen in our recently announced diversity and inclusion initiatives (https://president.cornell.edu/diversity-and-inclusion-initiatives/), we will be conducting a comprehensive review of student mental health at Cornell. Beginning this semester, Cornell Health will work with the campus community to determine the appropriate scope for this review, which could potentially begin in early 2019. Vice president Lombardi also shared this news with our students in a message sent on September 18, along with other updates and investments in mental health support services.

The team at Cornell Health—those in both clinical and educational roles—have advocated for this review to provide an opportunity to look holistically at mental health on our campus. We also continue to engage with and support mental health resources in the larger community.

Thank you again for reaching out to me and for your advocacy for providing the best possible environment to support the mental health of Cornell students.

Sincerely,

Martha E. Pollack

Tompkins County Adopts the Zero Suicide Model

The Tompkins County Legislature on Tuesday unanimously passed a resolution to support the Zero Suicide Model, calling on local healthcare and behavioral healthcare providers to follow the model’s systematic clinical approach to preventing suicides.

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Tompkins County Legislature July 17, 2018

“This is an initiative we can be proud of,” said Shawna Black, chair of the legislature’s Health and Human Services Committee, who sponsored the resolution. “We are going to be one of the first counties in New York State to implement Zero Suicide.”

“We have a lot of work to do as a county to support those that struggle with mental health issues,” Black added. “However, the conversation will continue and our goal of zero suicides will set the standard for our community and it’s providers. As a community we realize the need for honest conversation about suicide prevention and the tools we must implement in order to save lives. I would like to thank the many providers that offer service on a daily basis and for their commitment to the zero suicide initiative.”

The legislative passage of Resolution 7950 came a month after the newly formed Tompkins County Suicide Prevention Coalition voted overwhelmingly to recommend the Zero Suicide Model for healthcare providers as a countywide suicide prevention initiative.

Jay Carruthers, director of the New York State Office of Mental Health’s Suicide Prevention Office, commended the county’s efforts to implement Zero Suicide.

“The suicide prevention work done at the community level in Tompkins County over the last two to three years has been extraordinary,” Carruthers said in a statement to The Sophie Fund. “Creating community partnerships, raising awareness, decreasing stigma, forming a coalition, and most recently working to integrate suicide prevention in health and behavior healthcare services—the Zero Suicide Model—it’s a wonderful accomplishment.

“In fact,” Carruthers added, “a big topic of conversation at Governor Andrew Cuomo’s Suicide Prevention Task Force this year has been how to support robust suicide prevention at the local level. No one approach is going to be enough to materially reduce the number of suicides. It takes community-level public health approaches, a commitment to deliver suicide safer healthcare, and the creation a culture of data-informed programming. The partnership between Tompkins County and the state has been truly exemplary in moving in this direction.”

Sharon MacDougall, Tompkins County deputy commissioner of mental health services, said “the support from our community, the Tompkins County Health and Human Services Committee, and the Legislature is inspiring and incredibly meaningful to our behavioral health providers and clients. Tompkins County Mental Health Services is honored to collaborate with our partners to push forward a vision and commitment for Zero Suicide in our community.”

MacDougall noted that including Tompkins County Mental Health Services, a total of seven local healthcare providers have become “Zero Suicide Champions” by committing to implement the model: Cayuga Medical Center; Alcohol & Drug Council of Tompkins County; Suicide Prevention & Crisis Service; Cornell Health of Cornell University; Family & Children’s Service of Ithaca; and CAP Plan/Preferred.

David Shapiro, president and CEO of Family & Children’s Service, commented: “F&CS has for many years been at the forefront of suicide prevention in Tompkins County through the staff training, team support, and clinical supervision that have become hallmarks of our clinical program. F&CS is one of the founding members of the Tompkins County Suicide Prevention Coalition. Along with committing to the Zero Suicide Model, F&CS is also committed to be a Zero Suicide Champion and will share what we learn with the broader community so that we can all be better prepared to help people who may be at risk to commit suicide. Our commitment to the Zero Suicide Model sets a lofty goal with an aspirational challenge.”

Kent Bullis, executive director of Cornell Health, commented to The Sophie Fund: “Cornell Health supports the Zero Suicide model, and is committed to completing the Zero Suicide Organizational Self-Study this summer and reporting out our experience to the Tompkins County Suicide Prevention Coalition in the spring.”

In March, Cayuga Medical Center became the first major healthcare provider in Tompkins County to endorse the Zero Suicide initiative. “Cayuga Medical Center is committed to Zero Suicide and is currently studying what resources we need to implement,” David Evelyn, vice president for medical affairs, told The Sophie Fund. “We are pursuing the self-assessment.”

In comments to the Legislature prior to Tuesday’s vote, Scott MacLeod of The Sophie Fund said that “adopting the Zero Suicide Model is an important step in addressing the public health problem of suicide and the rising suicide rate.” The Sophie Fund sponsored The Watershed Declaration adopted exactly 15 months earlier in which local healthcare providers pledged to intensify suicide prevention efforts in Tompkins County. The Sophie Fund also co-hosted an expert briefing on the Zero Suicide Model last October at The Statler Hotel on the Cornell campus.

MacLeod thanked the Tompkins County Legislature and the Zero Suicide Champions for their support for the Zero Suicide Model. He also thanked and cited the valuable support provided by Jay Carruthers, director of the state Suicide Prevention Office; Associate Director Sigrid Pechenik; Garra Lloyd-Lester, associate director of the Suicide Prevention Center of New York State; and Michael Hogan, a former New York State mental health commissioner and a developer of the Zero Suicide Model.

The Tompkins County resolution reads in part:

WHEREAS, the Tompkins County Suicide Prevention Coalition endorses the Zero Suicide model as a framework for organizational commitment to safer suicide care in health and behavioral health care systems, and

WHEREAS, suicides are preventable, now therefore be it

RESOLVED, on recommendation of the Health and Human Services Committee, That Tompkins County hereby signs onto the Zero Suicide model to reduce the number of people committing suicides, commit to sharing lessons learned with other counties to support a state-wide initiative and encourage all health and behavioral healthcare to participate in the Zero Suicide model…

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Shawna Black (center), chair of the Health and Human Services Committee

The Zero Suicide Model, sometimes called the “Suicide Safer Care Model,” holds that suicides can be prevented by closing cracks in healthcare systems—that suicide deaths for individuals under care within health and behavioral health systems are preventable.

Specifically, this entails a systematic clinical approach in healthcare systems—training staff, screening for suicide ideation, utilizing evidence-based interventions, mandating continuous quality improvement, treating suicidality as a presenting problem—and not simply relying on the heroic efforts of crisis staff and individual clinicians.

As the Suicide Prevention Resource Center (SPRC) puts it:

“The programmatic approach of Zero Suicide is based on the realization that suicidal individuals often fall through multiple cracks in a fragmented and sometimes distracted healthcare system, and on the premise that a systematic approach to quality improvement is necessary.”

The facts make a compelling case that healthcare settings must play a critical role in preventing suicide. A review of New York State data of 3,564 suicides in 2013–2014 identified that 25 percent of the individuals who took their own lives had been discharged from emergency departments or inpatient facilities within just seven days prior to their suicide deaths.

The data also indicates a strong need to better train clinicians in suicide screening, assessment, intervention, and follow-up. Of 1,585 mental health providers surveyed by the New York State Office of Mental Health in 2014, 64 percent reported little or no specialized training in suicide-specific interventions. Moreover, about 33 percent reported that they did not feel they had sufficient training to assist suicidal patients.

Zero Suicide is at the heart of the 2012 National Strategy for Suicide Prevention, released by the U.S. Surgeon General and the National Action Alliance for Suicide Prevention. The NSSP’s Goal 8 is to “promote suicide prevention as a core component of healthcare services.” Goal 9 is to “promote and implement effective clinical and professional practices for assessing and treating those at risk for suicidal behaviors.”

Zero Suicide is explicitly embraced by the NYS Suicide Prevention Plan 2016–17, entitled 1,700 Too Many. Implementing Zero Suicide in health and behavioral healthcare settings is the first pillar of the suicide prevention strategy outlined in the plan. The second pillar is to “create and strengthen suicide safer communities.”

The Zero Suicide Model builds on breakthroughs such as the Perfect Depression Care Initiative implemented in 2001 by the Henry Ford Health System in Michigan. Its comprehensive approach to mental and behavioral healthcare—incorporating suicide prevention as an explicit goal—demonstrated a 75 percent reduction in the suicide rate among Henry Ford health plan members.

Cornell Says “No” to Independent Review of Mental Health Policies

Cornell University President Martha E. Pollack this week rejected a request to establish an independent task force to review the mental health challenges facing Cornell students as well as the university’s policies, programs, and practices to address them.

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Cornell University President Martha E. Pollack

The request was made 10 months ago by Scott MacLeod and Susan Hack, the parents of Sophie Hack MacLeod (’14), a Cornell fine arts student in the School of Architecture, Art, and Planning who died by suicide in Ithaca at age 23 on March 26, 2016 while on a health leave of absence taken in her senior year.

The request was originally sent in a letter to Interim President Hunter R. Rawlings III and then forwarded to Pollack after she took up her post as Cornell’s 14th president in April 2017. The letter was also cc’d to Cornell Board of Trustees Chairman Robert S. Harrison.

In the detailed 13-page letter dated March 27, 2017, MacLeod and Hack said that in their experience as the parents of a Cornell student who took her own life they observed “systemic failure” in Cornell’s mental health policy and practice affecting areas such as suicide prevention, mental health counseling, and sexual violence.

This, they wrote, included a failure to “fully and openly recognize the magnitude of the mental health challenges facing Cornell, and to address them with best practices backed by human and financial resources commensurate to the scale.”

MacLeod and Hack said they observed “an institutional mindset reflecting complacency and defensiveness that appears to prioritize Cornell’s public image over the welfare of students struggling with mental disorders.”

Describing the mental health crisis confronting today’s college students, MacLeod and Hack cited several studies including the 2016 annual report of the Center for Collegiate Mental Health. The report said that collected data from 139 college counseling centers showed that 33.2 percent of 150,483 college students seeking counseling in the 2015-16 academic year had “seriously considered attempting suicide.” That was a marked increase from 23.8 percent in the 2010-11 academic year. The data also showed that 9.3 percent of the students seeking counseling had reported actually making a suicide attempt.

The letter went on:

“In a constructive spirit, we call on you to establish an independent, external-led task force on student mental health without delay to review and assess the mental health challenges for Cornell students and the university’s policies, programs, and practices to address them; and to make recommendations to the Cornell President to ensure that the university is adopting and implementing current best practices.”

In her initial response on May 3, 2017, Pollack did not address the request for an independent review but thanked MacLeod and Hack for “voicing your broader concerns about Cornell’s policies and programs regarding student mental health.” She added, “We strive to always be open to how we can do better.”

In an email on January 11, Pollack turned down the request for a task force. She also declined a November 28 follow up request from MacLeod and Hack for a meeting to discuss the request for an independent review with the Cornell president in person.

Pollack’s email said in part:

“Please know that we share your commitment to ensuring that we provide the best support possible for our students. …

“We have been thoroughly reviewing our operating standards and capacity at Cornell Health this fall, including institutional and board-level conversations about the operational and strategic direction of the center. On a related note, we reviewed our most recent external assessment provided by the JED Foundation along with their subsequent visit to our campus this past summer. We will continue ongoing engagement with the foundation to ensure we are providing holistic support.

“While I acknowledge your request that we establish an additional independent review of the Cornell Health operation, it is not our intent to do so. We appreciate your support and look forward to our continued collaboration in the future.”

MacLeod and Hack established The Sophie Fund in their daughter’s memory in 2016 to advocate for mental health initiatives aiding young people in Ithaca and Tompkins County.

Commenting on Pollack’s decisions, MacLeod and Hack said in a statement:

“We have done our best to responsibly bring our concerns to the attention of the university’s senior leadership. President Pollack’s decisions don’t improve our confidence that Cornell has grasped the magnitude of its mental health challenges or fully stepped up to meet them. We hope the internal review she speaks of will be comprehensive and not limited to Cornell Health, and that its findings will be transparently released to the Cornell and Ithaca communities.”

According to Cornell’s website, it ranks 14th among the world’s universities in the 2018 QS World University Rankings, with an enrollment of about 22,000 students.